1. Tracy Brower, Ph.D., MM, MCR
Michael Parkinson, MD, MPH, FACPM
What it really takes:
Health, well-being & productivity improvement
in the workplace
It’s totally possible.

2. Today’s speaker
Dr. Michael Parkinson | Principal | P3 Health
• Key medical advisor for Limeade
• Principal of P3 Health, EVP and CMO of Lumenos
• Previous President of American College of Preventive Medicine
• MD from George Washington University, MPH from John
Hopkins and AB from Cornell University

3. Overview #WhatItReallyTakes
@Limeade

4. Understand the drivers of health
and productivity in the workplace, and
how to address them in your
own organization.
Goals

5. What are we trying to do anyway?
$2.8T on
healthcare:
75% behaviors
30% waste

6. Framework: Workforce well-being & business performance
Well-being
status
Workplace
practices
Individual well-
being
Individual
performance
Org
performance
* Adapted from Sherman BW, Lynch DL. Am J Managed Care 2014: 20(2) 155-120
Work factors
Workplace
Culture

7. Healthy
| Minimal preventable illness and injury
Productive
| Contributes to the corporate mission and achieves personal goals
Ready
| Responds to changing demands
Resilient
| Adjusts to setbacks or unusual challenges
Do you have a healthy workforce?
Adapted from IOM: Integrating Employee Health: A Report for NASA 2007

8. Determinants of health
Social
environment
Physical
environment
Genetic
environment
Health Disease Healthcare
Individual
response
Well-being Prosperity
“Live, learn,
work and play”
Evans, R. G., Barer, M. L., & Marmor, T. R. (1994)
Why Are Some People Healthy and Others Not?. New York: Aldine De Gruyter

9. $0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
19-34 35-44 45-54 55-64 65-74 75+
Medium Risk
High Risk
Non-Participant
Low risk
Behaviors drive ALL costs
Edington. Am J Health Promotion 15(5):341-349, 2001

10. IOM 2011: The Healthcare Imperative: Lowering Costs and Improving Outcomes
Unnecessary services
Inefficient delivery
Excess admin costs
Excessive prices
Missed prevention
Fraud
Where’s the waste?
30%excess waste
$750B
in waste

12. Employer health & productivity roadmap™*
Increase
Healthy
Behaviors
Optimize
Environment
Optimize
Chronic
Care
Speed
Care
Transitions
Minimize
Acute
Care
Reduce
Excessive
Surgery
Reduce
Excess
Surgery
*Parkinson MD. Employer Health and Productivity Roadmap™ Strategy, JOEM 55 (12) Supp Dec 2013.

14. Optimize the environment
2
Culture
| Policies, leadership
Programs & health
| Wellness program, resources, communications
Roles, responsibilities & rewards
| Policy alignment, compensation and benefit alignment
1 4 652 3 4 5 61

15. Optimize the environment
2
Alignment of rewards and responsibilities leads to:
| Reduce medical spend by $2,500 PPPY
| Decrease STD up to 50%
| Decrease worker's compensation up to 65%
| Decrease turnover for top performers up to 50%
| Increase revenue up to 35%
1 4 652 3 4 5 61

16. Increase healthy behaviors
Incentivized health management program
or consumer-directed health plan
2
Competency based programs address
root cause of disease & costs
| Tobacco cessation
| Physical activity
| Stress management
| Weight management
1 4 652 3 4 5 62

17. Minimize acute care
Healthy people use less acute care
| Traditional and alternative care
| Virtual visits
| Costs and on-site care options
| Prevalence of acute visits
1 4 652 3 4 5 63

18. Optimize chronic care
2
2
| Condition prevalence
| ID & referral process
| Disease management coaching
1 4 652 3 4 5 64

19. Coaching
2
2
| Prepare to make changes
| Set goals
| Facilitate problem solving
| Develop self-efficacy & gain support
| Build skills
| Engage in medical decision-making
with doctor
1 4 652 3 4 5 64

20. Coaching and tools
Lifestyle
improvement
Nutrition
Tobacco cessation
Physical activity
Stress management
Chronic disease
Cardiovascular conditions
Depression
Diabetes
Maternity
Shared decision
support
Back & knee pain
Breast cancer
Heart disease
1 4 652 3 4 5 64

21. Reduce excess surgery
2
2
25%
of all surgeries
are unnecessary
(RAND)
O’Connor et al. 2003, Armstrong et al 2012; Lee et al 2013
*Whelan et al. 2004; Kennedy et al. 2002; Murray et al. 2001; Deyo et al. 2000;
Morgan et al. 2000; Bernstein et al. 1998; Barry et al. 1997; Street et al. 1995
| Shared decision-making before surgery
| Reduce:
- # of surgeries
- Advanced imaging rate
| Expand to more discretionary surgeries
| Utilize decision aids
1 652 3 4 5 65

22. Informing patients
*Foundation for Informed Medical Decision Making survey, 2009 (n=462)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Managing conditions
Changing behaviors
Taking new Rx's
Surgery
Cancer screenings
Patients actually informed Important for patients to be Informed?
1 652 3 4 5 65

23. “Patient activation” – why
it matters
| Better health behaviors
| Better clinical care and
clinical outcomes
| Overall lower cost
* J Gen Int Med 2012;27:52026 and Health Aff 2013;32:216-222
1 652 3 4 5 65

24. Speed care transitions
Incentivized health management program
or consumer-directed health plan
2
Goal: Get employees back to work
| Address conditions that drive employees
away from work
| Reduce frequency of absences
| Monitor return to function and work by
major condition
1 62 3 4 5 66

26. Invest in employees’ well-being
| Support & reward behavior change
| Tools & resources
| Biometric screenings
| Interventions & coaching
Workplace wellness programs tie it together
Improve
Health
Well-Being
Performance

27. | Engaging in wellness is a must
| Employees & families want it
their way
| Technology is changing the game
| Mobile, devices, self-monitoring,
bio feedback, virtual coaching
How technology is driving the future

28. | Cash/gift cards
| Nudge messaging
| Loss aversion
| Default option
| Commitment contract
| Peer support group
| Tech/web support
New vocabulary of behavioral economics
CMS RFI “Beneficiary engagement, incentives and behavioral insights” due Sep 15, 2014

29. | Recognize financial stakes
| Emphasis on preventive
care
| Less medical service
overuse
Consumer directed
healthcare
“It’s my health
and my money,
and I’m going to
take better care
of both.”

30. Physical
activity
Attitude of
self, sense
of purpose
Whole-food,
plant-based
diet
What I eat, how I move, what I think
The 3 fundamentals of health

31. Whole person approach
• Benefit
design/incentive
driven
• Clinical engagement
program
• Member services
• 24/7 nurse line
• Employee assistance
program
• Worksite health clinics
• Central leave management
• Disability
• Coaching
• Physical condition
management
• Behavior condition
management

34. About Limeade
Incentivized health management program
or consumer-directed health plan
2
Limeade is a corporate wellness technology company that
measurably improves employee health, well-being and
performance, while building cultures that support well-being.
limeade.com
marketingteam@limeade.com